Diabetes and Gum Disease

Effects of Gum (Periodontal) Disease on Diabetes

It has long been known that diabetes can make gum disease much more difficult to treat. New studies now show that the reverse is also true; periodontal disease can negatively affect diabetes.

An important work by B.L. Mealy, the author cites numerous studies that indicate that the presence and severity of periodontal disease can increase the risk of poor blood sugar control in diabetics. One study clearly illustrates the relationship between periodontal disease, diabetes, and heart problems. When compared to diabetic patients with minimal periodontal disease, those with severe periodontal disease have a significantly greater number of cardiovascular complications. These include stroke, angina, and heart failure. The study concludes that the association between heart disease and severe periodontitis in diabetic individuals requires attention and close cooperation between the physician and dentist.

Several of the studies reported by Mealy state that successful treatment of the type of periodontal disease implicated in diabetes may actually improve the diabetic's ability to control diabetes. These studies are important for at least two reasons. First, it is more difficult to control diabetes in those with periodontal disease. And second, the American Heart Association now includes diabetes as a major risk factor for heart disease, ranking it with high blood pressure and smoking.

How Diabetes Effects Gum Disease

Large epidemiological studies have confirmed that diabetes increases the risk of gum inflammation and destruction. It is believed that to the extent that the body can control diabetes plays a determinant role in the risk for periodontal disease. When the diabetic condition is not controlled the greater is the prevalence and severity of periodontal disease. Diabetes should be considered a strong risk factor for advanced gum disease but its impact on periodontal disease is highly dependent on the severity of the underlying risk factor, such as the degree of blood-sugar control. Poor blood sugar control is a major risk factor for classic diabetes complications and periodontal disease may be associated with them.

Although there are no known definitive reasons why periodontitis can impact blood sugar control in diabetics, a few theories have been put forth. In both diabetic and non-diabetic individuals, acute bacterial and viral infections cause an increase in the body’s resistance to insulin, which aggravates blood sugar control. In diabetic individuals, the insulin resistance of cells is already enhanced and further infection can exacerbate the resistance and significantly worsen its ability to regulate blood sugar. Thus, gram-negative periodontal infections may increase insulin resistance and worsen blood sugar control, similar to systemic bacterial and viral infections. In addition, periodontal treatment, both at the dental office and at home, which decreases the amount of bacteria and reduces inflammation, might restore insulin sensitivity over time, with a concomitant improvement in blood sugar control.

Relationship of Gum Disease to Diabetes

In summary, it is reasonable to conclude that periodontal disease and diabetes have a complex interaction that only now is being clarified at the cellular level. Evidence now supports diabetes as a risk factor for periodontal disease and periodontal infection can adversely impact blood sugar control in diabetic individuals.

Thus, we witness an unfortunate interrelationship in that:

• Diabetes is on the rise;

• It is a risk factor for heart disease;

• Periodontal disease affects a large percentage of the population; and

• Periodontal disease is a risk factor in both diabetes and heart disease

Once again we see that the damage done by gum disease is not limited to the teeth and gums. I strongly recommend that anyone with diabetes, regardless of the severity, should have a thorough oral health examination and if gum disease is found, every effort should be made to eliminate it.

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